In the Matter Of: in the Probate Court

No. 2016-GD______-2

IN THE MATTER OF: IN THE PROBATE COURT THE GUARDIANSHIP OF   NUMBER _____ OF  INCAPACITATED/MINOR  TARRANT COUNTY, TEXAS

ANNUAL ACCOUNT FOR THE PERIOD THROUGH ______

TO THE HONORABLE JUDGE OF SAID COURT:

NOW COMES ______, Guardian of the Estate herein, and respectfully presents this verified account pursuant to the provisions of Section 1163 of the Texas Estates Code.

1. PERIOD OF ACCOUNT. This accounting covers the twelve-month period shown above.

2. OPENING FIGURES. The property of the Estate, as shown on the [ Inventory, Appraisement & List of Claims (or) the last Annual Account] approved on ______, was as follows:

REAL PROPERTY ______$ ______$ ______TOTAL REAL PROPERTY $ ______

PERSONAL PROPERTY Confirmations of securities are attached. ______$ ______$ ______TOTAL PERSONAL PROPERTY $ ______

CASH ON HAND Listed by account number and bank location ______$ ______$ ______TOTAL CASH ON HAND $ ______

OPENING FIGURES – TOTAL PROPERTY AND CASH ON HAND $ ______

3. PROPERTY NOT PREVIOUSLY REPORTED. The following property has come into the hands of your Guardian which has not been previously reported to the court: None, (or) ______$ ______$ ______TOTAL PROPERTY NOT PREVIOULSY REOPRTED $ ______

4. CHANGES. The following changes have occurred in the condition of the Estate which have not been previously listed or inventoried: None, (or) A. By Order signed ______$ ______B. By Order signed ______$ ______C. ______$ ______TOTAL CHANGES IN PROPERTY $ ______

5. RECEIPTS. The receipts of the Estate are as shown in the attached Exhibit “A”, and are summarized as follows: Interest on Estate Accounts $ ______Refunds $ ______Rental Income $ ______Dividends $ ______Proceeds from Sale of Estate Assets $ ______$ ______$ ______TOTAL RECEIPTS $ ______

6. DISBURSEMENTS. The disbursements of the Estate are as shown in the attached Exhibit “B”, and are summarized as follows: Support and Maintenance $ ______Attorney’s Fees $ ______Bond Premium $ ______Bank Charges $ ______Taxes $ ______Expenditures authorized by Court Order $ ______$ ______$ ______TOTAL DISBURSEMENTS $ ______

7. PROPERTY AND CASH ON HAND. The property currently being administered and cash remaining in the hands of your Guardian is as follows:

REAL PROPERTY ______$ ______$ ______$ ______TOTAL REAL PROPERTY $ ______

PERSONAL PROPERTY Confirmations of securities are attached ______$ ______$ ______TOTAL PERSONAL PORPERTY $ ______

CASH ON HAND Verifications are attached ______$ ______$ ______TOTAL CASH ON HAND $ ______

8. SAFEKEEPING. The following assets belonging to the estate are being held subject to safekeeping agreements: Confirmations of safekeeping are attached. None, (or) ______$ ______$ ______TOTAL ASSETS IN SAFEKEEPIING $ ______

9. CLAIMS. The claims which have been presented against the estate are as follows: None, (or) Claimant’s Nature Amount allowed Amount Amount Amount name & address of claim and approved rejected paid allowed but not paid ______TOTAL CALIMS $ ______

10. UNPAID DEBTS The following debts and expenses of the estate have not been paid and are presently due and owed by the Estate: None ______$ ______$ ______$ ______$ ______TOTAL UNPAID DEBTS $ ______

11. OTHER FACTS NECESSARY FOR A FULL UNDERSTANDING OF THE CONDITION OF THE ESTATE, INCLUDING, BUT NOT LIMITED TO THE PAYMENT OF INSURANCE AND TAXES, IF ANY, ON ASSETS OF THE ESTATE: ______

12. RECONCILIATION. The following is a summary and reconciliation of the foregoing paragraphs of this account. CASH TOTAL ESTATE 12.2 OPENING FIGURES $ ______$ ______12.3 PROPERTY NOT ______PREVIOUSLY REPORTED 12.4 CHANGES IN PROPERTY ______12.5 RECEIPTS ______12.6 DISBURSEMENTS (______) (______) TOTAL 12.2 THROUGH 12.6 $ ______$ ______12.7 PROPERTY AND CASH ONE HAND ______12.8 ASSETS IN SAFEKEEPING ______TOTAL 12.7 THROUGH 12.8 $ ______$ ______12.9 CLAIMS ______12.10 UNPAID DEBTS AND EXPENSES (______) TOTAL NET VALUE OF ESTATE $ ______

Respectfully submitted,

______, Guardian

______ATTORNEYS FOR GUARDIAN THE STATE OF TEXAS   COUNTY OF TARRANT 

Guardian, ______, being first duly sworn, upon his/her oath, deposes and says that:

I am the Guardian in the above entitled and numbered cause. I have read and examined the foregoing Annual Account which is to be filed in this cause and: A. The account contains a true, correct and complete statement of the matters to which the account relates; B. the guardian has paid the bond premium for the next accounting period; C. the guardian has/has not filed all tax returns of the ward due during the accounting period. D. no taxes were owed by the ward during the accounting period. (or) the guardian has/has not paid all taxes the ward owed during the accounting period; 1. the amount of the taxes was $ ______2. the date the guardian paid the taxes was ______3. the governmental entity to which the taxes were paid is ______. (or) the guardian has NOT paid all taxes the Estate owed during the accounting period for this(these) reason(s): , (or) the Guardian has NOT filed all tax returns of the Estate due during the accounting period for the reason that ______

______Guardian

SWORN TO AND SUBSCRIBED this ____ day of ______, 20___.

______Notary Public, State of Texas ______Notary’s Printed Name Notary’s Commission Expires No.______

IN RE: THE GUARDIANSHIP  IN THE PROBATE COURT  OF ______ NUMBER ____ OF  INCAPACITATED/MINOR  TARRANT COUNTY, TEXAS

VERIFICATION OF FUNDS ON DEPOSIT

The undersigned, an officer of the financial institution named below, hereby certifies that ______, Guardian of this Estate, had on deposit with this institution as of ______in the following accounts, the amounts shown below:

Checking Account No. ______$ ______

Savings Account No. ______$ ______

Certificate of Deposit No. ______$ ______

Signed this ______day of ______, 20 _____.

______Bank Fort Worth, Texas

By ______Name: ______Title: ______No. ______

IN RE: THE ESTATE  IN THE PROBATE COURT  OF ______ NUMBER ____ OF   TARRANT COUNTY, TEXAS

VERIFICATION OF SECURITIES

The undersigned, an ______, hereby certifies that ______, Guardian of this Estate, had on deposit with ______as of the __ day of ______, 20__, the following assets:

______$ ______$ ______$ ______$ ______$ ______$ ______

SIGNED this _____ day of ______, 20__.

______No. ______

IN RE: THE GUARDIANSHIP  IN THE PROBATE COURT  OF ______ NUMBER ____ OF  INCAPACITATED/MINOR  TARRANT COUNTY, TEXAS

CONFIRMATION OF SAFEKEEPING

The undersigned, an officer of the financial institution named below, hereby certifies that ______, Guardian of the Estate, had on deposit with this institution as of ______in the following accounts, the following described securities or other assets held subject to orders of the Court:

Checking Account No. ______$ ______Savings Account No. ______$ ______Certificate of Deposit No. ______$ ______$ ______$ ______$ ______

SIGNED this ______day of ______, 20__.

______, Bank Fort Worth, Texas

By ______Name: ______Title: ______No. ______

IN RE: THE GUARDIANSHIP  IN THE PROBATE COURT  OF ______ NUMBER ___ OF  INCAPACITATED/MINOR  TARRANT COUNTY, TEXAS

ORDER APPROVING ANNUAL ACCOUNTING

On this day the Annual Account of this Estate was heard and considered by the Court, and after examining the Account and hearing the evidence in support of same, the Court finds as follows:

1. That the Court has jurisdiction of this proceeding and of the subject matter as required by law; 2. The Annual Accounting has remained on file for a full ten days before being considered; 3. That the Annual Account has been audited and settled by the Court complies with the law in every respect and should be approved as filed.

IT IS, THEREFORE, ORDERED ADJUDGED AND DECREED that the Annual Account filed herein by Guardian on or about ______is hereby APPROVED, and the Clerk of this Court is FURTHER ORDERED to re-issue Letters of Guardianship consistent with the prior orders of this Court.

SIGNED this ______JUDGE PRESIDING APPROVED: ______Telephone: ______Telephone: ______Telecopier: ______Telecopier: ______ATTORNEY FOR GUARDIAN ATTORNEY AD LITEM